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30 The General Medical Council
WHAT ARE THE OBLIGATIONS OF DOCTORS TO THEIR
PATIENTS?
e GMC denes the duties and obligations of doctors to their patients in its guid-
ance document ‘Good Medical Practice’ (GMP).
1
e GMP guidelines emphasise
the importance of doctors placing their patients’ needs at the centre of their prac-
tice and maintaining high standards of professionalism and ethical conduct.
Some key obligations include:
●
Putting patients rst: Doctors must prioritise their patients’ care. is means
providing good quality care, treating patients with respect and dignity and
acting in their best interests.
●
Communicating eectively: Doctors must listen to their patients and commu-
nicate eectively with them.
●
Obtaining informed consent: Doctors should explain diagnosis and treatment
options clearly to patients and ensure that they have the information they
need to be able to make informed decisions about their care. ey should
respect patient autonomy.
●
Working collaboratively: Doctors must work collaboratively with patients
and other health care professionals to provide the best care. is includes
respecting the roles and expertise of others and working in partnership with
patients to develop care plans that meet their needs.
●
Maintaining trust: Doctors must be honest and trustworthy in all their pro-
fessional dealings and act with integrity.
●
Continuing professional development: Doctors must keep their knowledge
and skills up to date and ensure that they are providing care based on the
latest evidence and best practice.
●
Maintaining professional boundaries: Doctors must maintain appropriate
professional boundaries with their patients, avoiding any behaviour that may
be interpreted as exploitative or abusive.
●
Raising concerns: Doctors should raise concerns if they believe that patient
safety or care is being compromised.
e document ‘Good Medical Practice’ provides more detailed guidance on
these and other issues.
WHAT IS THE DIFFERENCE BETWEEN BREACH OF DUTY
AND BREACH OF THE GENERAL MEDICAL COUNCIL’S
GOOD MEDICAL PRACTICE GUIDANCE?
Breach of duty for the purposes of a legal claim for medical negligence and breach
of GMP are two distinct, albeit related, concepts.
Breach of duty refers to a situation in which a health care professional fails to
provide an appropriate standard of care to a patient. A legal concept, it is typi-
cally assessed based on the objective standard of what a reasonably competent
health care professional would have done in similar circumstances. A breach of
https://t.me/med1917
General Medical Council investigations 31
duty may occur when a doctor fails to diagnose or treat a patient appropriately or
when they make a mistake during a procedure.
Breach of GMP, by contrast, refers to a situation in which a doctor violates
the ethical and professional standards dened by the GMC in their GMP guide.
is may include failing to maintain appropriate professional boundaries with
patients, failing to communicate eectively with patients or colleagues and
engaging in behaviour that is considered unprofessional or unethical.
While breach of duty and breach of GMP may overlap in some situations, a
breach of GMP does not necessarily equate to a breach of duty and vice versa. For
example, a doctor who breaches GMP by failing to communicate eectively with
colleagues may not have breached their duty of care if they still provided appro-
priate medical treatment. Similarly, a doctor who breaches their duty of care by
providing substandard treatment may not have breached their duty of care if they
were acting in good faith and following ethical principles.
A breach of duty may lead to legal action in a civil court, with the claim being
brought by the patient or their family.
A breach of GMP may result in regulatory action by the GMC.
GENERAL MEDICAL COUNCIL INVESTIGATIONS
e GMC’s role is to protect patients by ensuring that doctors meet the GMP
standards. e focus is on whether a doctor is t to practise as a doctor.
Some examples of issues that the GMC may investigate include:
●
Complaints from patients or their families about the care provided by a doc-
tor, including allegations of negligence or unethical behaviour
●
Concerns raised by colleagues or employers about a doctor’s conduct, perfor-
mance or health
●
Criminal convictions or charges against a doctor
●
Breaches of the GMC’s professional standards or ethical guidelines
●
Failure to meet the requirements for continuing professional development or
revalidation
Fitness to practise investigations are not intended to punish doctors for past mis-
takes or behaviour but rather to ensure that there are no concerns that would
undermine public condence in the profession or put patients at risk should a
doctor continue to practise. erefore, it is rare for the GMC to consider isolated
mistakes in patient care, particularly when the individual has complied with all
professional and ethical values and behaviours expected of a doctor when an
adverse incident has occurred, has explained what has happened and the likely
eects, has done what they could to put matters right, has apologised and has
demonstrated that they have learned from the incident and taken steps to mini-
mise the risk of the error being repeated.
Any concerns about a doctor’s tness to practise should be raised as soon as
possible. Apart from exceptional circumstances, the GMC will only consider
complaints raised within 5 years of the incident.
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32 The General Medical Council
e GMC aims to complete investigations as quickly as possible, and it has
set targets for the time to complete various stages of the investigation process.
For example, the initial assessment of a complaint should be completed within 5
working days, while an investigation must be concluded within 12 months. e
length of an investigation can vary depending on the complexity and seriousness
of the case, the amount of evidence to be gathered and assessed and the avail-
ability of witnesses and experts.
While an investigation is ongoing, to protect the public and maintain public
condence in the medical profession, the GMC may refer the case to the MPTS
for an interim orders tribunal hearing and seek interim orders, such as a suspen-
sion or conditions on a doctor’s registration. An example of such a restriction is
to stop the doctor from operating unsupervised or without seeking agreement
on the necessity of the surgery with a colleague. Interim orders are regularly
reviewed, and the GMC must apply to a court to extend them beyond certain
time limits.
Depending on the severity of the case and the ndings of the investigation, a
number of potential outcomes may follow a GMC investigation, such as:
●
No further action
If the GMC nds no evidence of serious misconduct or incompetence, it may
decide to take no further action and close the case.
●
Advice or guidance
e GMC may provide advice or guidance to the doctor, such as recommend-
ing changes to their practice or providing education and training.
●
War ning
If there are no concerns that the doctor poses a risk to the public, but the
GMC considers that their behaviour or performance was below the standard
expected, the GMC may issue a formal warning to the doctor, which will be
recorded on their registration and may be taken into account in any future
investigations or proceedings. Warnings are published on the GMC website
for 2 years and can be disclosed to employers on request.
If the doctor refuses to accept a warning, the GMC will refer the matter to
an Investigation Committee hearing, which can impose the warning or decide
to take no further action.
●
Undertakings
In more serious case s, but ones t hat fall short of requi ring the doctor to be str uck
o the register, the GMC may require the doctor to provide undertakings to
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The Medical Practitioners Tribunal Service 33
the GMC, such as agreeing to certain conditions on their practice or behav-
iour. Undertakings allow doctors to address concerns about their practice
while avoiding the need for formal disciplinary action and ensure that patients
are protected while the doctor takes steps to improve their practice.
Undertakings may include restrictions on the type of work that the doctor
can do, where they can work, how their work will be supervised and any addi-
tional training that should be undertaken. e doctor will usually be required
to keep the GMC informed of any changes to their practice. e GMC will
liaise with the doctor’s employer and responsible ocer to make sure the doc-
tor honours this agreement.
Undertakings are published on the GMC’s website and will remain visible
for 10 years aer the expiry of the undertaking.
Undertakings are legally binding, and failure to comply with the terms can
result in further action by the GMC, including a referral to the MPTS for a
formal hearing.
●
Referral to the MPTS for a hearing
THE MEDICAL PRACTITIONERS TRIBUNAL SERVICE
e MPTS is an independent adjudication body that is responsible for holding
hearings and making decisions on cases referred to it by the GMC. It is responsible
for ensuring that the tness to practise of doctors is assessed fairly and impartially.
e MPTS operates independently from the GMC and comprises independent
medical and lay members. e panel is chaired by a legally qualied person who
is not a doctor.
e tribunal has the power to make a range of decisions, including imposing
sanctions on a doctor’s registration or ordering them to take steps to improve
their practice. Its courses of action include:
●
Dismissing the case
If the MPTS nds that there is no case to answer or that the allegations are
unfounded, it can dismiss the case and clear the doctor of any wrongdoing.
●
Ordering the doctor to undertake training or retraining
e MPTS can require the doctor to undertake additional training or retrain-
ing to improve their knowledge, skills or practice.
●
Issuing warnings
e tribunal may issue a warning to the doctor if they have breached profes-
sional standards or if there are concerns about their tness to practise.
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34 The General Medical Council
●
Imposing sanctions on the doctor’s registration
is can include suspending the doctor’s registration, placing conditions on
their registration or removing them from the register (‘erasure’).
e doctor’s registration may be suspended for a specied period, which
means they cannot practise as a doctor during that time.
e tribunal may impose conditions on the doctor’s registration, such as
requiring them to work under supervision or limiting the types of patients
they can treat.
In the most serious cases, the doctor’s name may be erased from the medi-
cal register, which means they can no longer practise as a doctor in the UK.
●
Referring the case for a criminal investigation
If the tribunal believes that the allegations against a doctor are serious enough
to warrant a criminal investigation, it can refer the case to the appropriate
authorities.
Any decisions can be appealed through the courts.
NOTE
1. https://www .gmc -uk .org/- /media /documents /good -medical -practice--
-english -20200128 _pdf -51527435 .pdf.
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35
7
The Parliamentary and Health
Service Ombudsman
The Parliamentary and Health Service Ombudsman (PHSO) is an independent
body in the UK that investigates complaints about government departments,
public services and the NHS in England.
WHAT IS THE ROLE OF THE OMBUDSMAN?
Its key role is to hold public services to account by providing an independent
and impartial service for complaints that have not been resolved through other
channels.
e key responsibilities and functions of the PHSO include:
●
Investigating complaints: e PHSO has the power to investigate complaints
about a wide range of issues, including maladministration, service failure
and inadequate professional conduct.
●
Making recommendations: Aer completing an investigation, the PHSO
makes recommendations to the organisation or service provider involved,
as well as to government departments and other stakeholders. ese rec-
ommendations are designed to improve services, prevent similar problems
from happening in the future and provide redress for those aected by poor
service.
●
Raising awareness: e PHSO raises awareness of the importance of good
public service by publishing reports and highlighting issues and trends that
emerge from its investigations. It also works with other organisations to pro-
mote good practice and improve service delivery across the public sector.
●
Providing guidance and advice: e PHSO provides guidance and advice to
members of the public who are considering making a complaint, as well as
to organisations and service providers on how to improve their complaint
handling processes.
DOI: 10.1201/9781003179351-9
https://t.me/med1917
36 The Parliamentary and Health Service Ombudsman
WHAT ARE THE OBLIGATIONS OF PROFESSIONALS TO
THE OMBUDSMAN?
Health care professionals in the UK have certain obligations to the PHSO in rela-
tion to complaints made about them or the services they provide. ese obliga-
tions include:
●
Cooperating with investigations: Health care professionals have a duty
to cooperate fully with any investigations carried out by the PHSO. is
includes providing information and documentation as requested, attending
interviews or hearings and answering questions truthfully.
●
Providing accurate and complete information: Health care professionals must
provide accurate and complete information when responding to complaints
or inquiries from the PHSO. is includes providing information about their
own actions and decisions and the policies and procedures of the health care
organisation they work for.
●
Taking complaints seriously: Health care professionals have a duty to take
complaints made against them or their organisation seriously and to respond
to them in a timely and appropriate manner. is includes conducting inter-
nal investigations, providing explanations or apologies and taking steps to
address any issues that are identied.
●
Implementing recommendations: When the PHSO makes recommendations
as a result of an investigation, health care professionals have an obligation
to implement these recommendations to the best of their ability. is may
involve changes to policies, procedures or practice and may require addi-
tional training or resources.
●
Maintaining professional standards: Health care professionals have a duty to
maintain professional standards at all times and to act in the best interests
of their patients. is includes providing high-quality care, communicat-
ing eectively with patients and their families and treating everyone with
dignity and respect.
Overall, the PHSO ensures that complaints are handled in a fair and transpar-
ent manner and that the public can have condence in the health care system.
By complying with the obligations listed, health care professionals can help the
PHSO full its important role in promoting accountability and improving public
services.
COMPLAINT INVESTIGATIONS
e PHSO is not the rst point of contact for complaints and will only consider
investigating health care complaints aer all other avenues have been exhausted
and if certain criteria are met. ese criteria include:
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Complaint investigations 37
●
e complaint must be made by or on behalf of someone who has received
treatment or care from the NHS or other public health bodies in England.
●
e complaint must have already gone through the relevant NHS complaints
procedure. Before the PHSO can investigate a complaint, the complainant
must have gone through the health care provider’s complaints process and
received a nal response. If the complainant is not satised with the response
or a response is not received within 6 months, they can escalate to the PHSO.
●
e complaint should be about a matter of injustice or hardship resulting
from improper conduct by sta or maladministration or service failure by an
NHS organisation.
●
e complainant must have suered, or be likely to suer, as a result of the
maladministration or service failure.
●
e complaint must be about an issue that has not already been investigated
by the PHSO, unless new evidence has emerged.
●
e complaint must be about an issue that is within the PHSO’s jurisdiction.
●
e complaint must not be subject to legal proceedings, unless the PHSO has
agreed to investigate alongside the legal process.
If these criteria are met, the PHSO will consider the complaint and decide
whether to investigate.
e PHSO does not investigate all cases and will prioritise investigations
into complaints that are serious in nature, such as those involving serious harm
or death, those where wider public interest issues are raised and those where it
believes it can make the biggest dierence.
e PHSO may decline to investigate if the complaint is considered to be friv-
olous or vexatious or if there is insucient evidence to suggest that maladminis-
tration or service failure has occurred.
Typically, the PHSO will only consider complaints made within one year from
the date of the nal response from the health care provider, although some dis-
cretion is retained in relation to time limits.
e PHSO logs all complaints it receives about NHS-funded services so that
if it receives a similar complaint about the organisation or sees a pattern from a
number of complaints, it may be able to raise this with the organisation in the
future.
If the PHSO does investigate, it looks at each case individually.
e process includes an initial assessment in which the PHSO assesses the
complaint and issues raised to ensure that they are within its remit and that all
other avenues for complaints have been exhausted. If otherwise, the PHSO may
advise the complainant to pursue other options.
e PHSO then investigates the complaint by reviewing all the information
gathered and considering whether there has been any maladministration, service
failure or improper conduct by sta in the health care provider. e investigation
may also include seeking expert opinions and advice.
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38 The Parliamentary and Health Service Ombudsman
Once the investigation is complete, the PHSO prepares a dra report of its
ndings and conclusions. e health care provider and the complainant are
given an opportunity to respond to the report before it is nalised.
en the PHSO issues a nal report containing the ndings of the investi-
gation, any recommendations for actions and any remedies or compensation
that the PHSO considers appropriate. Remedies include requiring the health
care organisation to apologise to the complainant, calling for changes to prevent
such an incident from happening again and reviewing procedures. While the
PHSO can recommend compensation for inconvenience, distress and expenses
incurred, this is not designed to replace the legal process for claiming compen-
sation if there is negligence. When suggesting nancial payments, to help them
identify how much ought to be paid, the PHSO refers to its ‘severity of injustice
scale’ and payments previously recommended as part of its casework.
ereaer, the PHSO monitors the health care provider’s response to the
report and ensures that the recommendations are implemented. e PHSO may
also follow-up with the complainant to ensure that they are satised with the
outcome.
e length of time it takes for the PHSO to investigate a complaint can vary
depending on the complexity of the case and its workload. Some complaints may
be resolved quickly, while others may take several months or even years to inves-
tigate fully.
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39
8
The Care Quality Commission
The Care Quality Commission (CQC) is the independent regulator of health
and social care services in England. It has the power to take enforcement action
against providers who do not meet the required standards of care.
WHAT IS THE ROLE OF THE CARE QUALITY
COMMISSION?
Its main role is to ensure that health and social care services provide safe, eec-
tive, compassionate and high-quality care to those who use them.
e CQC sets standards and inspects health and social care providers, such as
hospitals, GP surgeries, care homes and domiciliary care agencies. It monitors,
inspects and regulates services to ensure that they meet the standards and takes
action if they do not.
e CQC also provides information and guidance to the public about health
and social care services. Ultimately, the CQC aims to improve the quality of care
for all people who use health and social care services in England.
WHAT ARE THE OBLIGATIONS OF PROFESSIONALS TO
THE CARE QUALITY COMMISSION?
Professionals who work in health and social care services have certain obliga-
tions to the CQC. ese obligations are designed to ensure that the CQC can
monitor and regulate services eectively and that providers are held accountable
for the care they provide. Some of the key obligations include:
●
Registration: Professionals who provide health and social care services must
register with the CQC. ese include individual practitioners, such as doc-
tors and nurses, and organisations, such as hospitals and care homes.
●
Compliance with standards: Professionals have an obligation to ensure that
the services they provide meet the CQC’s standards for quality and safety.
DOI: 10.1201/9781003179351-10
https://t.me/med1917
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